Evidence-based practice or practice-based evidence
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This document discusses evidence-based practice in healthcare. It begins by asking whether evidence-based practice or practice-based evidence is more important. It then discusses the need for evidence to make informed healthcare decisions and defines what counts as strong evidence, such as results from randomized controlled trials. The document examines where strong evidence can be found, such as in systematic reviews and meta-analyses of multiple studies. It emphasizes using the best available evidence to make decisions that suit each individual patient.
Evidence-based practice or practice-based evidence
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- 19. Evidence-based pratice • Why do we need evidence? • What is evidence? • What counts as evidence? • Where do we find evidence?
- 20. Why do we need evidence? • Opinion • Experience • Authority • Expertise • Commercial companies • Budgets
- 22. We used to be certain about • Blood letting • Grommets for “glue ear” • Episiotomy • Lignocaine to prevent cardiac arrest post heart attack • Egg white and Oxygen to heal pressure sores • Vigorous rubbing of the buttocks with alcohol to prevent pressure sores
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- 28. Pressure sore treatment (consecutive) • 1 patient heals • 2 “ “ • 3 “ “ • 4 “ “ • 5 “ “ • 6 “ “ • 7 “ “ • 8 “ “ • 9 “ “ • 10 “ “
- 29. Pressure sore treatment (simultaneous) • 9 out of ten improve • 8“ “ • 7“ “ • 6“ “ • 5“ “ • 4“ “ • 3“ “ • 2“ “ • 1 “ “
- 30. Probability • 10 out of ten improve • What about the 11th time?
- 31. What is evidence? • a thing or things helpful in forming a conclusion or judgment • that which tends to prove or disprove something; ground for belief; proof. • something that makes plain or clear; an indication or sign
- 32. What counts as evidence? • The outcome of systematic enquiry
- 35. The cardinal features of an RCT
- 37. The cardinal features of an RCT • Randomisation • Control • Blinding
- 38. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 38 Intervention Control group
- 39. Meta analysis • Meta-analysis is a statistical procedure that integrates the results of several independent studies considered to be “combinable.” • Well conducted meta-analyses allow a more objective appraisal of the evidence than traditional narrative reviews, provide a more precise estimate of a treatment effect, and may explain heterogeneity between the results of individual studies. • Ill conducted meta-analyses, on the other hand, may be biased owing to exclusion of relevant studies or inclusion of inadequate studies.
- 40. Meta-analysis Systematic reviews Relationship between systematic reviews and meta-analyses
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- 42. Regression towards the mean • In statistics, regression toward (or to) the mean is the phenomenon that if a variable is extreme on its first measurement, it will tend to be closer to the average on its second measurement—and if it is extreme on its second measurement, it will tend to have been closer to the average on its first.
- 46. Evidence-based practice • the practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical decisions. The term is sometimes used to denote evidence-based medicine specifically but can also include other specialties, such as evidence- based nursing, pharmacy, and dentistry.
- 47. Evidence-based medicine • The judicious use of the best current evidence in making decisions about the care of the individual patient.
- 48. Acceptable definition of EBP? • an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best. (Muir Gray)
- 49. Where do we find evidence? • Evidence synthesis databases
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